Background:
This study aimed to assess the efficacy and safety of minimally invasive percutaneous nephrolithotomy (MPCNL) versus standard percutaneous nephrolithotomy in patients with renal and upper ureteric stones.
Methods:
We conducted a pooled analysis on randomized controlled trials (RCTs). The eligible RCTs were selected from the following databases: MEDLINE, Embase, Web of Science, and the Cochrane Library. The reference lists of retrieved studies were also investigated.
Results:
Our analysis included 10 RCTs with 1612 patients. Pooled data from 10 RCTs revealed the following: stone-free rate (odds ratio = 1.46, 95% confidence interval (CI) [1.12,1.88],
P
= .004), operative time (mean difference [MD] = 4.10, 95% CI [–1.37,9.56],
P
= .14), length of hospital stay (MD = –15.31, 95% CI [–29.43,–1.19],
P
= .03), hemoglobin decrease (MD = –0.86, 95% CI [–1.19,–0.53],
P
< .00001), postoperative fever (MD = 0.83, 95% CI [0.49,1.40],
P
= .49), and urine leakage (MD = 0.59, 95% CI [0.25,1.37],
P
= .22). Besides, we performed sub-group analysis based on vacuum suction effect and multiple kidney stones. For vacuum suction effect, it revealed the following: stone-free rate in vacuum suction group (
P
= .007) and in non-vacuum suction group (
P
= .19). Operative time in vacuum suction group (
P
= .89), non-vacuum suction group (
P
= .16). Postoperative fever in vacuum suction group (
P
= .49), non-vacuum suction group (
P
= .85).
Conclusion:
This pooled analysis indicated that MPCNL was a safe and effective method for treating renal stones compared with standard percutaneous nephrolithotomy. Besides, the vacuum suction effect in MPCNL played a more important role. When it comes to multiple or staghorn stones, the longer operative time in MPCNL could not be ignored.
